Prostate cancer symptoms and what to do next

What tests can be done? What's BHP? Dr Cindy Pan answers the important and most common questions regarding prostate cancer symptoms and advises you on what to do next.

There may be no symptoms at all

The tricky thing about prostate cancer is that early on there are unlikely to be any symptoms at all since the growth is so small at the beginning and unlikely to put enough pressure on the urethra (the narrow tube that passes through the prostate gland, carrying urine from bladder to penis and beyond) to make much impact.

By time the cancer has progressed to advanced cancer and has spread beyond the prostate there may be symptoms such as pain, discomfort or burning with urination, difficulty passing urine (especially getting the urine stream started), passing urine more frequently (including many times through the night) or needing to go more suddenly or urgently as well as pain in the lower back, hips or upper thighs. There may also be painful ejaculation, blood in semen or urine, decreased sex drive or difficulty with erections.

What else could symptoms signify?

The thing is though, these symptoms are far from being exclusive to prostate cancer; there are a number of other conditions that can cause similar symptoms. For example, similar symptoms of urinary difficulty can also (more commonly) be caused by an extremely common condition called ‘benign prostatic hypertrophy’ or ‘BPH’ which as the name suggests is a benign (non-cancerous) condition. BPH is a far more common condition in which the prostate is enlarged and the extra tissue encroaches on the urethral passage leading to urinary difficulties but the enlargement is not cancerous and not really life-threatening, albeit it can significantly impair quality of life if left untreated for too long.

What tests can be done?

If you have any kind of symptoms such as those described above, you should of course see your GP who can talk to you, examine you and order the appropriate tests. As well as a PSA blood test andDRE (digital rectal exam or ‘finger in the back passage’) you may need a transrectal ultrasound (to look at the prostate tissue) and biopsy (to sample a small amount of prostate tissue for closer examination and to look for cancer cells).

What if it is BHP (Benign Prostatic Hypertrophy)?

If you turn out to have BPH, there are a number of options for therapy including medication or a surgical procedure, done by a urological specialist, that essentially bores out a bigger hole for the urine to get through more easily.

What if it shows cancer?

If it is cancer, the next step is to grade the severity and extent of the cancer since the impact of a small, contained, slow growing cancer is of course very different to a larger more aggressive cancer that has spread to other parts of the body. Depending on what type of cancer you have your specialists will counsel you as to your options which may include watchful waiting in the case of very early cancers that are ‘indolent’ or slow growing.

Can I be tested if I have no symptoms?

Of course you do not have to wait until you have symptoms to be assessed for prostate cancer. Many doctors advocate having an annual PSA blood test and DRE even when you have no symptoms. The age at which you should start this sort of testing will vary somewhat; your doctor will give you more tailored advice depending on your individual medical history, family history and other risk factors for prostate cancer.

When should I start being tested?

Some men may choose to begin testing from age fifty; others may start even sooner, especially if there is a strong family history such as having a father or brother (or brothers) diagnosed with aggressive prostate cancers at an early age. Having a strong family history of breast or ovarian cancer is also a potential risk factor as those who inherit the BRCA2 gene are at higher risk of breast, ovarian and prostate cancer and the prostate cancers arising in these men tend to be more aggressive.

What else can I do to decrease my risk?

While advancing age and family history are both significant risk factors that we cannot really change, there is one risk factor that may be subject to modification: obesity. Having a waist circumference of over 100 cm could increase your risk of prostate cancer as well as multiple other serious or life-threatening conditions like cardiovascular disease and diabetes. Achieving a healthy weight through eating well and being more active, such as by walking daily, can do a world of good.